Provider Demographics
NPI:1861715310
Name:CROSBY, CHELSEA LUNDSTROM (PA-C)
Entity type:Individual
Prefix:MISS
First Name:CHELSEA
Middle Name:LUNDSTROM
Last Name:CROSBY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:LUNDSTROM
Other - Last Name:WOODS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:16233 SYLVESTER RD SW STE 260
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3044
Mailing Address - Country:US
Mailing Address - Phone:206-835-7400
Mailing Address - Fax:253-426-6344
Practice Address - Street 1:16233 SYLVESTER RD SW STE 260
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3044
Practice Address - Country:US
Practice Address - Phone:206-835-7400
Practice Address - Fax:253-426-6344
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA.60135343363AM0700X
WAPA60135343363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0285886OtherL&I
WA0285887OtherL&I
WA2006147Medicaid
WA0261142OtherSTATE L&I
WA0285887OtherL&I